Application for Onsite Wastewater Subdivision Review and Approval
This information is provided by the Nebraska Department of Environment and Energy to assist the public and regulated community.
Form #: 12-008 Applications and Forms Revised: 10/1/24

Subdivision Review and Approval Application Instructions


Prior to construction of a development area where an onsite wastewater treatment system is proposed on any lot less than three acres in size, the owner of the development area must submit an application for subdivision review and receive approval from the Nebraska Department of Environment & Energy (NDEE) for the use of onsite wastewater treatment systems for the development area.

The application must include at a minimum the following or be submitted on a form provided by the Director:
  • The words “Application for Onsite Wastewater Subdivision Review and Approval”,

  • The owner’s full name (first name, middle initial, and last name), mailing address, and phone number,

  • The name of the business or legal entity if the application is for a business or legal entity,

  • The full name (first name, middle initial, and last name) of the Master or Journeyman Installer, Registered Environmental Health Professional, or Professional Engineer responsible for the siting and layout of the development area and their certification or professional license number, mailing address, phone number and email address,

  • The legal description (quarter section, quarter section, section, township, range) or the latitude and longitude (to four decimal places) for the planned development area,

  • The county of the location of the planned development area,

  • The statement “I swear or affirm that the application information and documentation submitted are true, complete, and accurate”, and

  • The owner’s signature and date the application is signed or if the application is signed by an authorized representative, the application must include:
  • A description of the representative’s authority to sign on behalf of the owner, and

  • The representative’s full name (first name, middle initial and last name), mailing address, and phone number.

The application must be accompanied by:

The following minimum site evaluation information should be clearly identified and shown on the plans:
  • Existing and planned elevation contour lines to show the direction and steepness of the slope of the ground surface and natural topographic features including lakes, ponds, streams, drainage ways, and ditches,

  • A benchmark or fixed reference point with north orientation clearly indicated, and

  • Cut and fill areas and planned changes to topography.

Other information, including but not limited to information for adjacent property to provide verification that setback requirements are met, may be required by the Department to allow adequate review of the proposed development area.

Drawings and soils information must be in accordance with the following:
  • For development areas with lot sizes less than 3 acres (12,140 sq. m), but greater than or equal to 1 3/4 acres (8,470 sq. m), the drawings must include the location of all onsite wastewater treatment systems, reserve areas and well locations for all lots.

Soil percolation tests and soil borings or site excavations must be conducted on a minimum of every fifth lot to determine the soil characteristics and evidence of groundwater.
  • For development areas with lot sizes less than 1 3/4 acres (8,470 sq. m), but greater than or equal to 1 1/4 acre (6050 sq. m), the drawings must include the location of all onsite wastewater treatment systems, reserve areas, well locations and areas for structures including the dwelling or non-dwelling facility location, driveway, and outbuildings for all lots.

For lots 1.25 to 3 acres in size, soil percolation tests and soil borings or site excavations must be conducted on a minimum of every fifth lot to determine the soil characteristics and evidence of groundwater.

For lots less than 1.25 acres in size, soil percolation tests and soil borings or site excavations must be conducted on every lot to determine the soil characteristics and evidence of groundwater.

Note:
Effective Oct. 1, 2009, any individual submitting any application or form that would derive public benefit from the state must also fill out a United States Citizenship Attestation form. This applies to individuals submitting the forms on their own behalf. If applicable, please fill out the United States Citizenship Attestation form below and submit it with the relevant applications and forms.


United States Citizenship Attestation Form
This Complete Form is only available as an Adobe Acrobat (PDF) file.
File size is 97 KB




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